The Pharmaceutical Journal
Vol 268 No 7185 p197-203
16 February 2002

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Chlorambucil is effective in uveitis that threatens sight

Short-term high-dose chlorambucil therapy may be a reasonable treatment option in patients with sight-threatening uveitis, say researchers.

Dr Debra Goldstein, University of Illinois, Chicago, and colleagues looked retrospectively at 53 patients who had been treated with the cytotoxic agent chlorambucil for severe, non-infectious sight-threatening disease that was poorly responsive to corticosteroids or in whom corticosteroids had caused unacceptable side effects.

The patients were treated for between seven and 40 weeks with a maximum daily dose of 10–30mg. At their last follow-up (range six months to 24 years, mean 4.3 years), 77 per cent of patients were in remission and there were no malignancies, although 5.7 per cent of patients were lost to follow-up. Reported side effects included secondary amenorrhoea, non-ophthalmic herpes zoster and testicular dysfunction.

The researchers say that most cases of uveitis are adequately managed with topical or oral corticosteroids. Because of the potential for serious side effects chlorambucil should be reserved for those patients in whom blindness is a possibility without immunosuppressive treatment. Patients should be warned of the risks of sterility and late malignancy, they add (Ophthalmology 2002;109:370).